1689052961 NPI number — LOVELL ORTRHODONTICS, PC

Table of content: (NPI 1689052961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689052961 NPI number — LOVELL ORTRHODONTICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOVELL ORTRHODONTICS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIGHT DAY ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689052961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1849 MAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-880-0965
Provider Business Mailing Address Fax Number:
709-251-8208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1849 MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-264-0081
Provider Business Practice Location Address Fax Number:
719-264-0615
Provider Enumeration Date:
05/07/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOVELL
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
NORMAN
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
970-880-0965

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)